Written by Julia Mor: “Julia Mor is a nutritionist working in healthcare and currently diving deep into the world of nutrition and behaviour with an MSC at Bournemouth University. She has a soft spot for exploring how gut health ties into our mental well-being and a particular interest in inflammatory bowel disease (IBD).”

Inflammatory Bowel Disease (IBD) is a chronic condition characterized by inflammation of the gastrointestinal tract, which includes Crohn’s disease and ulcerative colitis. While medical treatments play a crucial role in managing IBD, nutrition also plays a significant role in supporting overall health and managing symptoms. Individuals with IBD often face challenges related to nutrient and protein energy absorption, weight loss, and dietary restrictions. (Alexis et al 2014) Malnutrition is common, affecting up to 75% of patients with Crohn’s disease and 62% of patients with ulcerative colitis (Russell et all 2021) The World Health Organization defines malnutrition as “deficiencies, excesses or imbalances in a person’s intake of energy and/or nutrients”. (WHO 2022)

Role of Nutrition in IBD

· Nutrients deficiency: patients with IBD are at an increased risk of nutrient deficiencies due to malabsorption, reduced appetite, and increased nutrient loss during inflammation. Common deficiencies include iron, vitamin B12, vitamin D, calcium, and magnesium. It is essential to address these deficiencies to support overall health and to prevent complications

· Energy requirements: IBD can lead to weight loss and malnutrition. Meeting energy requirements becomes crucial to prevent muscle wasting and support the body’s healing processes. High-calorie, nutrient-dense foods can help individuals maintain a healthy weight and energy levels

· Dietary Triggers: Certain foods may trigger inflammation and worsen IBD symptoms. While specific triggers vary from person to person, common culprits include dairy, high-fiber foods, spicy foods, and certain fats. Identifying and avoiding individual trigger foods can help manage symptoms and reduce flare-ups

Given very individual exhibition of symptoms in every patient with IBD, it is crucial that individual nutritional support if given to all patients. IBD patients would benefit from tailored dietary advise, but those with diagnosed malnutrition should be referred for professional dietitian support. Below are few general strategies which patients and professionals can implement in order to avoid or manage malnutrition.

Nutrition Strategies for managing IBD

· Balanced Diet: Aim for a well-balanced diet that includes a variety of nutrient-dense foods. Include lean proteins, whole grains, fruits, and vegetables while being mindful of personal trigger foods. A dietitian can help tailor a nutrition plan to individual needs and preferences.

· Supplementation: In some cases, supplementation may be necessary to address nutrient deficiencies. Vitamin and mineral supplements, such as iron, B vitamins, and calcium, may be recommended under the guidance of a healthcare professional.

· Probiotics: Probiotics, or beneficial bacteria, may help support gut health by promoting a balanced microbiome. Discussing the use of probiotics with a healthcare provider is important, as individual responses to these supplements can vary.

· Hydration: Adequate hydration is crucial for individuals with IBD, especially during flare-ups. Diarrhoea and inflammation can lead to fluid loss, so it’s essential to replenish fluids regularly. Water, herbal teas, and broths are good hydration choices.

· Small, Frequent Meals: Eating smaller, more frequent meals can help manage IBD symptoms by reducing the strain on the digestive system. This approach may be more tolerable for individuals experiencing abdominal pain or discomfort.

· Food Journaling: Keeping a food journal can help identify patterns between dietary choices and symptom flare-ups. This information can be valuable for adjusting the diet to better manage IBD, especially to help identify any triggers.

Nutrition plays a vital role in managing Inflammatory Bowel Disease, contributing to overall well-being and symptom control. Individuals with IBD should work closely with healthcare professionals, including dietitians, to create personalized nutrition plans that address specific needs and preferences. By adopting a mindful and balanced approach to nutrition, individuals with IBD can enhance their quality of life and better manage the challenges associated with this chronic condition. If you are concerned about your patients nutritional status or health then please contact their IBD specialist multi-disciplinary team for support.

Reference list

Czuber‐Dochan, W., Morgan, M., Hughes, L. D., Lomer, M. C. E., Lindsay, J. O. and Whelan, K., 2019. Perceptions and psychosocial impact of food, nutrition, eating and drinking in people with inflammatory bowel disease: a qualitative investigation of food‐related quality of life. Journal of Human Nutrition and Dietetics [online], 33 (1), 115–127. Available from: https://kclpure.kcl.ac.uk/portal/en/publications/perceptions-and-psychosocial-impact-of-food-nutrition-eating-and-drinking-in-people-with-inflammatory-bowel-disease(2f07f551-bdf8-43c9-b55d-66e1cc1d1ca2).html [Accessed 11 Jan 2020].

Jean Guy Leblanc and De, A., 2013. Crohn’s disease : classification, diagnosis, and treatment options. New York: Nova Biomedical.

Prince, A. C., Moosa, A., Lomer, M. C. E., Reidlinger, D. P. and Whelan, K., 2014. Variable access to quality nutrition information regarding inflammatory bowel disease: a survey of patients and health professionals and objective examination of written information. Health Expectations, 18 (6), 2501–2512.

Russell, L. A., Balart, M. T., Serrano, P., Armstrong, D. and Pinto-Sanchez, M. I., 2021. The complexities of approaching nutrition in inflammatory bowel disease: current recommendations and future directions. Nutrition Reviews, 80 (2), 215–229.

World Health Organization, 2022. Malnutrition [online]. www.who.int. Available from: https://www.who.int/health-topics/malnutrition#tab=tab_1.